Age-adjusted (world) oral cancer (OC) incidence and mortality rates for Puerto Rico (PR) are among the highest in the Western Hemisphere. Early diagnosis of oral cancer will decrease the morbidity and mortality resultant from this disease and its treatment. The objective of Healthy People 2010 is to increase the percentage of oral and pharyngeal cancers (stage I, localized) detected at the earliest stage to 50%. Unfortunately, the Commonwealth of Puerto Rico appears to have a deficit in early cancer detection that is strikingly worse than the mainland U.S. We have reported an [unreadable]inverse triangle[unreadable] of invasive carcinomas to in situ carcinomas and premalignant oral cancer lesions, i.e., significantly more pathology sign-out diagnoses for oral cancer than the other lesion types. Thus, routinely including oral cancer examinations in clinical practice will detect both more pre-malignant and earlier oral cancers with the result of decreasing the morbidity and mortality in Puerto Rico. The long-term goal of this project is to strengthen secondary prevention of oral cancer by increasing the practice of head and neck examinations in dental practices in terms of the a) proportion of persons screened, b) the frequency of screenings (initial, recall exams), and c) the quality of the screenings. The Specific Aims are: 1) identify methods to change OC screening practice behaviors by dentists in Puerto Rico, 2) identify emerging technologies that will increase practitioner screening in Puerto Rico, 3) identify emerging social trends and activities that will increase practitioner screening in Puerto Rico , and 4) based on the findings from Specific Aims #1-3, define a pragmatic implementation strategy for increasing practitioner screening for oral cancer in Puerto Rico. To accomplish the Specific Aims, qualitative investigative methods (i.e., expert focus groups and key informant interviews) will be conducted to obtain the necessary data from Specific Aims #1-3 to allow accomplishing Specific Aim #4. Thus, culturally/professionally acceptable methods, technologies and activities can be developed that are recognized by the targeted group (dentists) as being acceptable as well as productive in increasing the frequency of oral cancer screenings. These objectives will be accomplished by an experienced multi-disciplinary research team. Significance: By focusing public health and professional activities on highly acceptable oral cancer screening dissemination and implementation operations that are based on the findings of this project, oral cancer morbidity and mortality will be decreased in Puerto Rico.